I spent some time watching the NFL draft this past weekend. For those who aren’t sports fans, the draft is an annual event where professional teams take turns selecting college players to join their roster. It’s a huge event (the 2014 NFL draft drew a record 45.7 million viewers). The NFL is so popular that an event where someone reads names off a paper had higher ratings than two basketball and two hockey playoff games, combined.
The draft is the culmination of a process where students who have been working to prove themselves in a competitive amateur environment are picked and contractually obliged to implement their skills on behalf of a professional organization.
Sound familiar? It should. In many ways, the draft is analogous to the residency match.
One of the most interesting features of draft coverage is that analysts offer scouting reports on players. They talk about how some are “athletic and instinctive” while others “need more polish but can eventually be a starter.” They discuss strengths and weaknesses and how players will perform at the next level.
Watching the scouts evaluate players got me thinking more about selection processes. Every field, whether it’s football, medicine, finance, or technology, has some criteria by which it evaluates prospective members. Intuitively, you might assume that the way the NFL looks at students would be different than medicine.
But as I thought about it more, I realized the fields have a lot in common. The similarities between the NFL and residencies highlight a model for how organizations evaluate talent.
Broadly speaking there are two types of information that organizations use to assess ability. One type is objective data, which I will term “measurables.” Measurables are standardized metrics that have a generally accepted meaning. The other type is subjective assessment, which I will refer to as “intangibles.” Intangibles are qualities that don't appear on a resume but are critical to a person’s effectiveness, whether it's on the field or in the hospital. Intangibles are therefore determined not by accomplishments, but by subjective evaluations, recommendations, and interviews.
Standardized testing: The first measurable is perhaps an obvious one. In medical school, there are few moments more anticipated than the board exams. Standardized tests are consistently rated as the most important factor in students’ residency applications.
Similarly, football players must complete a battery of standardized performance tasks. These are workouts for the most part (but include a multiple choice test too). Just as a medical student’s likelihood of matching to a certain program can dramatically improve or decline based on a Step 1 score, an athlete’s stock can turn on his 40 yard dash time.
Prior performance: Past performance is one of the most popular indicators for future potential. If a student performs well on medical school rotations, it’s reasonable to expect them to continue as a resident and attending. Grades are used to measure performance on rotations, with better grades suggesting more skill.
Athletes also display their skills in a collegiate environment. Their statistics reflect their ability to perform at a high level. If a player can set touchdown records in college, the hope is that they can do the same as a pro.
School reputation: A reasonable complaint regarding the “prior performance” metric is that medical students and college football players don't compete in a uniform environment. Contextual factors dictate what it means to perform at a high level. Stanford’s athletic conference, the Pacific 12, is one of the best in the country. Stanford football therefore competes against more talented opponents than many other teams. Success in this environment is that much more impressive.
While medical schools make an effort to standardize curricula, different institutions, and even different attendings within the same institution, have variable expectations for students. As a result, the same grade can mean different things depending on where it came from.
Since there is no perfect way to evaluate competitors across these different contexts, NFL teams and residencies often use a student’s school as a proxy to gauge performance expectations. Players coming out of top tier football programs or students coming out of prestigious academic institutions tend to get the benefit of the doubt.
Leadership: As I mentioned previously, intangibles are more difficult to assess but can be equally important in determining someone’s ultimate success. Leadership is one of the most sought after intangible traits, whether in medicine or football. Both residencies and NFL teams judge leadership skills through personal interactions (e.g. interviews), references (letters of recommendation or assessments from scouts/coaches), and by identifying examples of leadership qualities.
Examples of leadership can take many forms. In medicine, it often involves leadership roles in extracurricular activities, but it can also mean advocating for a patient or managing a complex case on rotations. Football players can display leadership in multiple forums as well, whether it is community engagement or guiding a team in a high pressure game situation.
Work ethic: It’s hardly a surprise that any competitive field values people that work hard. Even so, I think both medical students and athletes sometimes underestimate the importance of demonstrated work ethic.
In both medicine and football, the pool of people who meet a threshold level of skill is larger than the pool of people who will match into a competitive residency or who will be drafted. Organizations can therefore use work ethic as a differentiating factor to determine who is worth taking.
As with leadership, demonstrating work ethic can take many forms. It can be an attending or coach commenting on someone’s drive. It can take the form of a football player showing up to run drills after practice. Or it can manifest as a medical student completing one research project after another even while busy with school.
Fit: Lastly, organizations use “fit” as a somewhat undefined but important selection criterion. Certain residencies look for specific types of applicants. For instance, a very academic program may look for a student with an interest in research, while another program may want an applicant with geographic ties to the area.
For NFL teams, fit often refers to a positional need. If a team desperately needs a quarterback, they will likely draft a quarterback even if a supremely talented linebacker is available. In both the case of medicine and football, fit includes acknowledging and accepting an institutional culture.
This is necessarily an incomplete framework – an exhaustive list of the factors that go into judging medical students and college football players could fill several books. I also recognize that many of the metrics listed here are imperfect at best.
Regardless, it encompasses many of the key features that organizations use to evaluate talent, whether it's residency or an NFL team. With so many similarities, perhaps it’s only a matter of time before ESPN starts televising the drama of the match.
Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week; the entire blog series can be found in the Stanford Medicine Unplugged category.
Akhilesh Pathipati is a third-year medical student at Stanford. He is interested in issues in health-care delivery.
Photo by skeeze